Background: Pruritus is one of the most common problems in patients suffering chronic renal failure. Twenty five - 35% of predialysis patients and 60-80% of patients during dialysis complain pruritus.The exact pathophysiology of pruritus is unknown; however, some possible interactive factors include: histamine release from mast cells and basophiles, uremic skin, cutaneous mast cells proliferation, adipose cells atrophy, electrolyte imbalance, and accumulation of bile acids. Since histamine is the main proposed mediator in pruritus, the goal of this study was to evaluate the role of antihistamines in controlling of pruritus of patients with chronic renal failure. This study was done as a before - after study during one year period in dialysis department of Imam Khomeini hospital.Methods: Thirty patients complied with inclusion criteria were entered in the study.Treatment strategy was: 2 weeks treatment with hydroxyzine 25 mg TDS, followed by one week wash-out period, then 2 weeks ketotifen therapy 1mg BID and finally two weeks treatment with chlorpheniramine 4mg BD following one week washout period after ketotifen therapy. Pruritus severity before and after each treatment period was evaluated with Pruritus Severity Score (PSS) chart.Results: The mean PSS reduction by hydroxyzine, ketotifen and chlorphenirarnine, were 33%, 4.5% and 20%, respectively.Conclusion: PSS improvement with hydroxyzine and chlorpheniramine was statistically significant (p<0.001). However, ketotifen induced pruritus reduction was not considerably significant.

A 21-year-old woman referred with fever, generalized pruritus, cough and weight loss (about 8 kg) since 2 months ago. She was a housewife, living in north of IRAN. She was in good health before that time. She had no history of smoking or drug consumption and her medical history was negative except for a Cesarean section performed 2 years ago. Physical examination revealed oral temperature of 38.2°C and scratch marks all over the body without other abnormalities. The laboratory findings were as follows: WBC = 14 x 103 ml/ (neutrophils=26%, Lymph=21%, eosinophils=53%), Hb=11/4g/dl (MCV=85 fl), platelet= 269x 103/ml, ESR= 25 ml/h, serum IgE= 2400 lu/ml (normal up to 182). Bone marrow aspiration showed predominance of myeloid series with eosinophilia without any parasite, granuloma or malignant cells. Biochemistry, electrolyte, renal and liver function tests were normal. ANA, anti - DNA(ds), HBsAg, HCVAb and HIVAb were all negative.Angiotensin converting enzyme (ACE) level was normal. The serology of toxocara and echinococcus was negative. Spiral CT-scan of the chest, paranasal sinuses and echocardiography were normal. Spiral CT-scan of the abdomen with intravenous and oral contrast revealed multiple ill-defined hypodense foci in the liver (Figure 1).

Background and Aim: Pruritus is one of the most disabling complications in patients with chronic renal failure that have negative effect on patients’ quality of life. The aim of this study was to determine the frequency of the uremic pruritus and its associated factors in hemodialysis patients referred to the dialysis centers in Golestan Province.Methods: In this cross-sectional study, all 375 patients referred to eight dialysis centers in Golestan Province were selected via census sampling method. Data were gathered by using demogeraphic and Yosipovitch pruritus questionnaires. Data analysis was performed using SPSS software through conducting t and chi square tests.Results: The mean ± standard deviation of patients' age was 48.36±13.27 years and 51.2% of patients were male. One hundred and eighty one (48.3%) patients had uremic pruritus. The lowest and highest frequencies of pruritus among surveyed centers were 37.9% and 57.1%, respectively. 60.2% of patients had localized pruritus and the most common location was back (68.8%). There was a statistically significant correlation between uremic pruritus with number of dialysis session (P<0.001) and serum level of phosphorus (P<0.001).Conclusion: The results indicated that uremic pruritus is still one of the most common problems in hemodialysis patients. Therefore it seems necessary providing ways to eliminating or reducing the problem.

BACKGROUND AND OBJECTIVE: Diagnosis of hyperthyroidism and graves disease are not difficult due to typical symptoms. Sometimes manifestations of this disease are unusual. So final clinical diagnosis is important. CASE: In this study, 10 cases with thyrotoxicosis along with unusual manifestations were surveyed. Of these, 6 cases were male and 4 cases were female. They were at the 17-68 age groups with the mean of 48.2. The frequency of unusual symptoms were as follows: general PRURITIS without skin lesion (3 cases), anorexia and vomiting (3 cases), hypokalemic paralysis (2 cases), dysphagia with recurrent pulmonary aspiration (1 case), pretibial myxedema (1 case) and means lerman scratch (1 case). This interval between the beginning of symptoms and final diagnosis was different from 10 to 120 days. The thyroid function test showed hyperthyroidism in all cases. Another underlying disorder was not detected. All symptoms of patients were removed after antithyroid drugs therapy except pretibial myxedema (1case) and exophthalmos (2 cases). There was no complication during 18 month antithyroid therapy after interruption of drug, relapse of disease was seen in 3 cases.CONCLUSION: With regard to different manifestation of thyrotoxicosis, this disease should be considered in differential diagnosis, especially in older age groups with gastrointestinal, cardiac, cutaneous and musculoskeletal complaints.

Epidermolysis Bullosa Puriginosa is a genetic mechanobullous disease characterized by pruritus, lichenified or nodular prurigo-like lesions, occasional trauma-induced blistering, excoriations, milia, nail dystrophy and albopapuloid lesions that appear at birth or later. Scarring and prurigo are most prominent on the shins. Herein, we report a case with a history of blisters since childhood followed by intensely pruritic lesions predominantly on the shins and dystrophy of the toenails, milia, excoriations and diffuse post-lesional hyper and hypopigmentation.

Introduction: Uremic pruritus is characterized by an uncomfortable and unlimited sensation which leads to scratch, which strongly reduces the quality of life. Pruritus is a common symptom in patients with end-stage renal disease. Various clinical trial studies have examined the effects of acupuncture and acupressure on treatment of uremic pruritus. This systematic review meta-analysis aimed to evaluate the effectiveness based on published studies.Materials and Methods: An electronic literature search was conducted to identify appropriate trial studies. The results for continuous outcomes were presented as weighted mean difference, with 95% confidence intervals.Results: A total of 5 articles, including 6 trials, were enrolled in this systematic review. Only 3 of the six trial studies used a visual analogue scale score for assessing pruritus and acupressure for intervention regime, which were considered for meta-analysis. The combined results showed that acupuncture or acupressure was effective in treatment of uremic pruritus (pooled mean difference, -1.994; 95% confidence interval, -2.544 to -1.445).Conclusions: This study confirms that using acupuncture and acupressure is effective in treatment of uremic pruritus. However, further vigorous studies are needed to verify these findings.

BACKGROUND: The aim of this study was to evaluate the efficacy and side effects of tramadol comparing with meperidine on post-spinal shivering in cesarean section. METHODS: In a prospective, controlled, randomized, double-blind clinical trial 73 ASA-I pregnant patients candidates of cesarean section under spinal anesthesia who had shivering ostoperatively were selected and classified into two groups receiving tramadol or meperidine to control  ostoperative shivering. Spinal anesthesia was done by injection of epinephrinized 5% lidocaine at L3-L4 or L4-L5 segment. PRURITIS, somnolence, dizziness, nausea, vomiting and the duration of shivering control were evaluated and recorded. All data were analyzed by using Fisher and Chi-square tests.RESULTS: There were no significant differences between two groups in age (P = 0.1) and weight (P = 0.8) of patients. There was no significant difference in response rate after injection of both drugs (P = 0.3). The time elapsed from treatment to ceased shivering was significantly less (P = 0.001) but frequency of somnolence (P = 0.001), nausea (P = 0.001) and vomiting (P = 0.005) were significantly more in tramadol group. Dizziness was significantly more common in meperidine group (P = 0.001) and PRURITIS was not seen in any group.CONCLUSION: Tramadol is more effective in controlling post-spinal shivering but results in more frequent nausea, vomiting and somnolence in comparison with meperidine.    

Painless labor provides conditions for mother during painful contractions of uterus and dilatations of cervix. In addition to providing smooth progression of the process, the mother remains calm and pain free.Painlessness is produced by 3 methods: A -By systemic drugs, B - By regional methods, C- By non - pharmacologic methods. Some of the complications of painless labor are:1- sympathic block and hypotension, 2-motor nerve block, 3-nausea and vomiting, 4- urinary retention, 5-respiratory depression, 6- PRURITIS, 7- meningitis, 8-headache.This study was a cross - sectional descriptive study in which the complications of painless labor were assessed in 200 mothers during a 6 months period in Najmieh hospital.* 200 mothers with painless labor were included in this study and 2 women (1%)were hospitalized. one woman was hospitalized for severe headache because of spinal anesthesia and another because of sympathic block, hypotension and headache probably because of drugs side effects. 2 women (1%) had respiratory depression. 5 women (2/5%) had nausea and vomiting, 3 of them had G.A and 2 women had regional anesthesia (1 spinal & 1 epidural). 7 women (3.5%) had headache. 2 of them G.A and 5 women had regional methods. 3 women (1/5%) had PRURITIS and all of them had G.A anesthesia. 2 women (1%) had sympathic block and hypotension. One of them had G.A and another had regional anesthesia (spinal). And in 1 case, Ketamine had been administered. 2 women (1%) had urinary retention. None of the patients had convulsion, meningitis and motor nerve block.

Background and Objective: Mucocutaneons manifestations are common in hemodialysis patients. The aim of this study was evaluate the prcvalence of cutaneous and mucosal manifestations in end stage renal disease (ESRD) patients who are on the maintenance hemodialysis.Materials and Methods: This cross sectional study was performed on 100 (51 males, 49 females) hemodialysis patients in 5 Azar hospital in Gorgan, North of Iran during 2009. Patients selected on randomly based an all of them completely examined by a deramatologist for any changes in skin, hair, nail and mucous membrane. If necessary biopsy perform and refer to a pathologist. Data analysed with SPSS-13, mann-whitney, t-test, Chi-Square and Fisher tests.Results: The average age was 49±12.3 years. The most common causes of ESRD was dibetes mellitus. The most common skin lesion was xerosis (78.3%), after that PRURITIS (39.1%) lentigo (34.8%) skin discoloration (32.6%) leukonychia (32%) thining of nail bed (24%) were common lesions. Lentigo was more common in female than male 42.85% vs 21.50% (p=0.042). Xerosis (p<0.01), scaling (p=0.042), lentigo (p<0.01), folliculitis (p<0.01), idio pathic guttate hypopigmentation (p<0.01) leukonychia (p<0.01) and half and half nail (p<0.01) have meaningful correlation with age. There was also meaningful correlation between dialyis duration and skin discoloration (p<0.031) and leukonychia (p<0.041). Clubhing and ca-p product also have meaningful correlation (p<0.027). PRURITIS (p<0.048) and skin fungal infection (p<0.047) (tinea versi color) also have meaningful correlation with serum ferritin level.Conclusion: Mucocutaneous manifestation were common in end stage renal disease patients.

We present the case of a 3D-year-oldman, who was admitted to our institution with jaundice.He had nausea, anorexia, PRURITIS, dark urine and epigastric & RUQ shooting pain radiating to back and lasting for 10 days, with no other evidence of a generalized disease. Liver function tests were abnormal but other laboratory studies were almost within normal limits. lmaging procedures revealed multiple small gallstones plus a cystic lesion, 5 by 5 cm in diameter, in the left lobe of the liver. The patient underwent an elective cholecystectomy, hepatic needle biopsy and excisional biopsy of liver mass. The pathology report ascertained the presence of a benign mesenchymal hamartoma of the liver. Needle biopsy was normal.